scholarly journals Phototherapy in complex treatment of wounds in patients with ischemic and neuroischemic form of diabetic syndrome

2018 ◽  
Keyword(s):  
Wound Healing ◽  
Growth Factor ◽  
Diabetic Foot ◽  
Comparison Group ◽  
Local Treatment ◽  
Lower Extremities ◽  
Bone Defects ◽  
Main Group ◽  
Diabetic Foot Syndrome ◽  
Algorithm Analysis

The aim of the study was to improve results of wound healing in patients with ischemic and neuroischemic forms of diabetic foot syndrome by using a combination of phototherapy, platelet-derived growth factor and modern cover materials The results of surgical treatment of 48 patients with ischemic and neuroischemic diabetic foot syndrome, which were divided into main group (24 patients) and comparison group (24 patients). All these patients who underwent treatment in the Department of acute vascular diseases in the Clinic of the SI “Institute of General and Urgent Surgery named after V.T. Zaitsev of the National Academy of Sciences of Ukraine” suffered from diabetes mellitus type II and had IV degree of foot ischemia according to Fontaine. The diagnostic was performed for all patients according to a standard algorithm. Analysis of the results of clinical, laboratory, non-invasive and invasive methods of examination in the preoperative period enabled to determine the degree of disorder in blood flow, the nature of collateral circulation and microcirculation. Patients of both groups underwent femoro-tibial and femoro-popliteal bypass, as well as hybrid reconstructions. The parameters of regional hemodynamics in patients of main group and the comparison group before and after revascularization were comparable. The patients of main group used the treatment technology developed by us. In cases of development of phlegmons of the foot after the opening of the abscess, vacuum therapy was performed for 7–14 days until the wound was completely cleaned. In the preoperative preparation complex, phototherapy was performed, according to local situation, wounds were irradiated with different wavelengths (405, 470 or 525 nm). After the wounds were cleaned, the wound defect was covered with PCL coating (Nanopharma, Czech Republic) with the application of a fibrin clot and platelet-rich plasma without fibrin, after which further local treatment was accompanied by irradiation of wounds with A. Korobov-V. Korobov photon matrices “Barva-Flex” (the wavelength of the maximum of the emission band of 660 nm). In two cases, the closure of bone defects with ILAYAOSTEOGEN® “A.A. PARTNERS” L.L.C. bone implants of medical company “ilaya” was used. Using these tactics, allow to achieve complete wound healing in 91.7% of patients and partial healing (more than 50%) in 8.3% of patients in main group. The terms of treatment of these patients did not exceed 2 months, high amputations were not required. In patients of comparison group against the background of traditional local treatment, the wounds healed within 2–4 months; in eight cases, repeated hospitalization was required to perform a plastic closure; in two cases amputation was performed below the knee. Thus, phototherapy and plastic closure of wounds of the lower extremities after revascularization in isch- emic diabetic foot syndrome is indicated in cases where the wounds have no tendency to spontaneous healing; introduction of the developed tactics of treatment of “problem” wounds of the lower extremities allowed to achieve complete healing in 91.7% of patients, partial (more than 50%) healing in 8.3% of patients and avoid high amputations; the use of a complex of treatment including phototherapy, wound closure with a synthetic coating with platelet growth factor, and the closure of bone defects with implants is an extremely effective stim- ulator of development in the wound of granulation tissue suitable for further autodermoplasty

scholarly journals Morphological research of the effectiveness of perioperative local use of anesthetics and antiseptics in patients with purulent-necrotic lesions of lower extremities in diabetes mellitus

2021 ◽  
Vol 27 (3) ◽  
pp. 22-28
Author(s):  
Yu.M. Babina ◽  
D.V. Dmyrtriiev ◽  
O.A. Nazarchuk ◽  
P.P. Hormash
Keyword(s):  
Diabetes Mellitus ◽  
Wound Healing ◽  
Granulation Tissue ◽  
Diabetic Foot ◽  
Povidone Iodine ◽  
Local Treatment ◽  
Lower Extremities ◽  
Diabetic Foot Syndrome ◽  
Patients With Diabetes ◽  
Infiltration Anesthesia

Ulcer-necrotic lesions of the feet are detected in 5-15% of patients with diabetes mellitus (DM). According to the literature today in Ukraine, patients with DM perform high amputation of the lower extremities with diabetic foot syndrome with a frequency of 19.6-42.6%, at the same time, mortality ranges from 8.9% to 25.0%, and the total mortality rate at the DM varies from 6.6% to 13.5%, often associated with the occurrence of postoperative complications. The aim of the work was to study morphological indicators of reparation of soft tissues of the lower extremities in patients with diabetic foot syndrome on the background of local treatment during the perioperative period. We investigated changes in histologic structure and character of reactions of skin tissues, muscles and fascia during the period of visceral disease in patients with diabetes mellitus after different types of local treatment. Then, samples of skin tissues, muscles and fascia were photographed and analyzed using a light microscope OLIMPUS BX 41. In the first group of the comparison, which used standard methods of anesthesia and local antiseptic povidone-iodine, granulation tissue was characterized by the complete absence of fibrous structures (collagen fibers) and the presence of a small number of newly formed small diameter vessels with blistered endothelium. Vessels of young granulation tissue were dilated, full-blooded, the endothelium was swollen, there was significant perivascular edema. In the second group of patients (where povidone-iodine and infiltration anesthesia with 2% lidocaine solution anesthetic was used locally) there were almost no remains of necrotic tissues in the affected tissues. It should be noted that there was better granulation development with fewer inflammatory-cell elements, more young forms of fibroblasts and a moderate pathological vascular reaction. In the first (control) group, wound healing by 3-7 days is characterized by somewhat slow regeneration. Wound healing was most favorable in patients of the second group, where infiltration anesthesia was used by local anesthetic and antiseptic povidone-iodine.

scholarly journals Clinical-functional and morphological parameters of purulonecrotic foci healing in diabetic foot syndrome using programmable sanitation technologies

2021 ◽  
Vol 5 (3) ◽  
pp. 260-275
Author(s):  
Vladimir A. Sergeev ◽  
Alexander A. Glukhov ◽  
Alexander S. Sorokin ◽  
Sergey A. Zhuchkov ◽  
Alexander V. Gorokhov ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Surgical Treatment ◽  
Diabetic Foot ◽  
Comparison Group ◽  
Local Treatment ◽  
Main Group ◽  
Diabetic Foot Syndrome ◽  
Morphological Parameters ◽  
Supporting Function ◽  
Fold Reduction

Diabetes mellitus is currently characterised by a high progressive prevalence of patients. The purpose of this study is to evaluate the clinical, functional, and morphological parameters of purulonecrotic foci healing in diabetic foot syndrome (DFS) using programmable sanitation technologies. The patients were randomised into two groups. In the comparison group (n=51), patients received conventional local treatment after surgery. In the main group (n=55), after surgical treatment, the wound was sutured, and in the postsurgical period, programmable sanitation was conducted using the AMP-01 device. The cytological smears of the main group identified a higher rate of cellular reactions in the wound. There was a 1.3-fold reduction in the duration of hospitalisation, the number of purulent complications was significantly less (p=0.014). It was possible to preserve the supporting function of the foot in patients of the main group in a larger percentage of cases (p=0.023). There was a statistically significant increase in the frequency of high amputations in the comparison group (p=0.026). As a result, the effectiveness of the use of programmable sanitation technologies for purulent lesions of the diabetic foot has been proven.

scholarly journals OPTIMIZATION OF THE VACUUM-ASSISTED TREATMENT FOR COMPLICATIONS OF DIABETIC FOOT SYNDROME

2019 ◽  
Vol 23 (5-6) ◽  
pp. 15-19
Author(s):  
V.I. Liakhovskyi ◽  
O.O. Kyzymenko ◽  
O.H. Krasnov ◽  
O.I. Krasnov ◽  
T.V. Horodova-Andrieieva
Keyword(s):  
Diabetic Foot ◽  
Topical Treatment ◽  
Comparison Group ◽  
Local Treatment ◽  
Main Group ◽  
Diabetic Foot Syndrome ◽  
Comprehensive Treatment ◽  
Vacuum Therapy ◽  
Second Phase ◽  
Wide Range

The nature of reparative and morphological changes in wounds was examined against the background of vacuum therapy in the comprehensive treatment of purulent and necrotic lesions of diabetic foot syndrome. We conducted comprehensive examination and treatment of 107 patients with DFS of grade II-IV according to Meggit-Wagner. The average age of patients was 53.2–4.3 years; there were 39 (36.4%) male and 68 (63.6%) female patients. Depending on the methods of topical treatment, patients were divided into two groups. The main group consisted of 55 (51.4%) subjects who underwent vacuum therapy during the topical treatment, and the comparison group comprised 52 (48.6%) patients who received standardized local treatment depending on the course of the wound process. In addition to the clinical studies, all patients underwent a comprehensive laboratory and instrumental examination, as well as measuring the area and pH of wounds on the 1st, 4th, 7th, 10th and 13th day after surgery. The analysis of the obtained results gives ground to establish that at a certain level of pH, there is a corresponding cytological pattern. The wide range of fluctuations in the pH of the wound medium in patients with purulent and necrotic lesions of diabetic foot syndrome leads to corresponding changes in cells, which is manifested by a long-lasting inflammatory process. In the main group, the rate of wound reduction was greatest on the 8th-10th days, and in the comparison group – on the 14th-15th days. Inpatient treatment was 14.2 bed-days in the main group and 23.5 ± 2.9 in the comparison group (p <0.05), respectively. Therefore, there is an acceleration of positive changes in clinical manifestations, cytological, morphological and pH-metric pattern against the background of conducting VT for an average of 5-7 days. The use of vacuum therapy makes it possible to accelerate the transition to the second phase of the wound process, which affects not only the time of treatment but also the outcome – preservation of the lower extremity in patients with diabetic foot syndrome.

scholarly journals Ways to reduce the frequency of high amputations, post-amputation complications and mortality in diabetic foot syndrome

2021 ◽  
Vol 8 (1) ◽  
pp. 12-23
Author(s):  
V. M. Bensman ◽  
A. G. Baryshev ◽  
S. N. Pyatakov ◽  
K. G. Triandafilov ◽  
V. N. Ponomarev ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Diabetic Foot ◽  
Soft Tissues ◽  
Comparison Group ◽  
Lower Extremities ◽  
Limb Ischemia ◽  
Main Group ◽  
Diabetic Foot Syndrome ◽  
Wound Complications ◽  
Comparison Groups

Despite the success in treatment, currently 30.0% of patients with diabetic foot syndrome (DFS) still undergo high amputations with a mortality rate of up to 54.0–68.0 %. The causes of high low limb amputations in 28.0 % of patients are infection, and in 46.0 % – arterial insufficiency in the stage of critical limb ischemia.Objective: to improve the results of patients treatment by reducing the number of high amputations of the lower extremities, reducing the occurrence of complications and deaths of the disease.Materials and methods. To study the results of treatment of patients with DFS, they were divided into two comparison groups and two main groups. From 1982 to 2019, the frequency of amputations, mainly at the hip level, was 71.0 % (177 amputations in 248 patients). These patients formed the first comparison group of observations. The second comparison group (1988–1994) included 58.3 % of patients in whom amputations were performed according to more stringent indications (157 amputations in 269 patients). The first main group of observations (1995–2013) included 9.9 % of patients with DFS who were amputated only for wet gangrene, incurable critical limb ischemia, and infection with a systemic inflammatory response (130 amputations out of 1312 patients). In ischemia with preserved blood flow through the deep artery of the thigh, amputation of the lower leg was performed in a sequential-two-flap method with removal of the soleus muscle. Amputations were completed with the imposition of drainage removable muscle-fascial sutures. The second main group (2014) consisted of 11.4 % of patients who underwent amputations only for sepsis or wet gangrene (124 amputations in 1083 patients). The difference between the second main group and the first was the division of the high amputation intervention into 2 stages.Results. Comparison of the treatment results in the main groups and in the comparison groups revealed a 6-fold decrease in the number of high amputations (from 64.6 to 10.69 %) and a significant improvement in the main quality indicators. This concerns a 6-fold decrease in mortality, which was a consequence of the introduction of a two-stage tactic for high amputation treatment of the most severe patients and the limitation of indications for amputation of the hip. Using of removable drainage muscle-fascial sutures decreased postoperative wound complications from 51.9 to 13.0 %, and the number of re-amputations decreased in 17th times.Conclusion. Amputation of the lower extremities for irreversible critical limb ischemia can be performed with a decrease in TcP02 of the stitched stump tissues to no more than 30 mm Hg. Preserving the knee joint improves the possibilities of prosthetics, which allows older diabetics to lead an active life. Methods of performing parallel- or sequential-two-flap high amputation improve the conditions for cutting out racquet-shaped wound flaps, which provides free displacement of the soft tissues of the stump connected by removable drainage sutures.

scholarly journals Modern approaches to local treatment of pyo-necrotic complications of the diabetic foot syndrome

2012 ◽  
Vol 93 (2) ◽  
pp. 301-303
Author(s):  
L E Slavin ◽  
B N Godzhaev ◽  
A Z Zamaleev
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Healing Process ◽  
Local Treatment ◽  
Water Soluble ◽  
Diabetic Foot Syndrome ◽  
Layered System ◽  
Second Phase ◽  
Bathing Solution ◽  
Optimal Conditions

The analysis of publications devoted to modern methods of treatment of pyo-necrotic complications of diabetic foot syndrome has been presented. Identified were the most important principles of therapeutic tactics for this type of pathology. In order to create optimal conditions for wound healing after surgical sanitation local drug treatment is carried out - a thorough wound detersion with application of the isotonic sodium chloride solution or a neutral bathing solution, periodic (as needed) necrectomies, application of bandages, in accordance with the phase of wound healing process. The choice of medication for local treatment depends on the one hand on the type of lesion of the lower limbs, on the other - on the diabetes related morbidity and phase of wound healing. In the first phase of wound healing antiseptics are used: iodophors, polyhexanide (lavasept), hydroxymethyl quinoxaline dioxide (dioxidine), and in the absence of ischemia - compositions based on gelevine, water-soluble base ointments. In the second phase used were various wound covers based on collagen, as well as oil and hydrogel dressings. Ready-to-use bandages are also used, which are multi-layered system, comprised of a cellulose substrate, collagen, fibroblasts, growth factor, coated with plates of silicon to control humidity. The disadvantage of the ready-to-use dressings is the impossibility of controlling the wound on a daily basis. One of the trends in the treatment of chronic diabetic wounds is the use of living skin cells that serve as a source of growth factors, cytokines and other proteins that stimulate the healing process. The use of local immunomodulators is seen as promising. Treatment should be individualized and systemic antibiotic therapy is required. The main principle of local treatment is the creation of optimal conditions for accelerating the healing process.

scholarly journals Peculiarities of treatment and healing of trophic ulcers of the lower extremities of the mixed genesis

2019 ◽  
Vol 86 (7) ◽  
pp. 36-41
Author(s):  
V. I. Liakhovskyi ◽  
O. M. Bezkorovaynyy ◽  
A. V. Sydorenko
Keyword(s):  
Blood Supply ◽  
Comparison Group ◽  
Healing Process ◽  
Local Treatment ◽  
Lower Extremities ◽  
Main Group ◽  
Local Temperature ◽  
Group I ◽  
Group Ii ◽  
The Impact

Objective. To study the impact of sulodexide on the healing process of trophic ulcers of the mixed genesis in the lower extremities. Materials and methods. Analysis of the medical cards data was done for 105 patients, who in 2015 - 2019 yrs have had treated the trophic ulcers of the mixed genesis of the ankles in Department of Vascular Surgery of the Poltava Regional Clinical Hospital. The causes of development of trophic ulcers were confirmed by data of ultrasonographic color angioscanning of the lower extremities and pelvis with measurement of the ankle-brachial pressure index and arteriography. All the patients did not accepted the proposal for performing of correcting and restoration surgical treatment on the lower extremities vessels. Depending on the treatment prescribed the patients were divided into two groups. Into the Group I (comparative) 53 (50.5%) patients were included, who obtained a casual conservative treatment, directed to improvement of the lower extremities blood supply, as well as the blood rheological properties, which included venotonic, analgesic, antibacterial preparations and local treatment, depending on the wound process stage. Into the Group II (the main) 52 (49.5%) patients were included, who on the background of typical treatment have obtained sulodexide in a dose 600 LU (lipoproteidlipase units) on 200 ml of physiological solution of sodium chloride up to 15 days long with subsequent therapy in the dose of 1 capsule twice a day (500 LU) during up to 60 days. In the Group I there were 32 (60.4%) men and 21 (39.6%) women, and in the Group II – 30 (57.7%) men and 22 (42.3%) women. Average age of patients in the Group I have constituted (65.8 ± 4.38), and in the Group II – (66.2 ± 5.04) yrs old. The pain intensity in accordance to the ten-point numerical rating scale was checked before the treatment beginning, in 7 and 14 - 15 days, the trophic ulcers square was measured, local temperature of the patient’s body, pН-metry and cytological investigations of the wounds exudate were done in all the patients before the treatment. Besides this, 38 (71.7%) patients of the comparison group and 40 (76.9%) patients of the main group were followed during 90 - 120 days after leaving a stationary. Results. In the patients, who have obtained sulodexide additionally, reparative processes in the trophic ulcers regions of the lower extremities have become accelerated, the pain syndrome have been lowered rapidly, the water index normalized, the blood supply improved, the ankle-brachial index enhanced, a local temperature raised, cytological picture of the wound exudate improved, what promoted more rapid healing of ulcers and reduction of the stationary stay duration. During the planned visits of the patients in 90 - 120 days a complete healing of trophic ulcers of the lower extremities in 31 (77.5%) patients of the main group and in 24 (63.2%) patients of the comparison group was proved. Conclusion. Application of sulodexide in the treatment dosage is expedient to include into complex of treatment for trophic ulcers of the mixed origin in the lower extremities.

scholarly journals Vacuum therapy in complex treatment of neuropathic form of diabetic foot syndrome in Ghana

2020 ◽  
Vol 5 (3) ◽  
pp. 16-24
Author(s):  
W. M. Rdeini ◽  
V. A. Mitish ◽  
Yu. S. Paskhalova ◽  
S. L. Sokov
Keyword(s):  
West Africa ◽  
Diabetic Foot ◽  
Local Treatment ◽  
Main Group ◽  
Diabetic Foot Syndrome ◽  
Comprehensive Treatment ◽  
Vacuum Therapy ◽  
City Hospital ◽  
Study Results ◽  
Antiseptic Solutions

Diabetic foot syndrome (DFS) is a serious public health problem in developing countries, where medical resources are limited, and the vast majority of patients turn to medical facilities too late with severe forms of the disease and often in advanced stages.Objective: to evaluate the effectiveness of negative pressure wound therapy (NPWT) in treating patients with a neuropathic form of DFS compared with traditional methods to reduce the number of high amputations and overall mortality in Ghana.Materials and research methods. A prospective, non-randomized, comparative clinical study of the results of examination and treatment of 59 patients with type 2 diabetes mellitus (DM) was performed at the Seventh-day Adventist City Hospital (Ghana, West Africa), Kumasi University Hospital and the Effiduase District Hospital (Ghana, West Africa) in the period from January 1, 2011 to December 31, 2013, there were 37 female patients (63.3 %), 22 male patients (36.7 %). The volume of foot tissue damage varied from II to IV degree according to Wagner classification (II degree was diagnosed in 55.6 % of cases). The average age of patients was 31.5 ± 7.3 (20–72) years. The average duration of DM was 7.3 ± 4.2 years. Bacteriological examination of wounds showed that Staphylococcus aureus was most often an isolated pathogen. All microorganisms identified from patients’ wounds had high resistance to commonly used antibiotics. Patients were randomly assigned to groups. NPWT is the only topical treatment in the main group; traditional dressings with antiseptic solutions (iodophors) were used in the comparison group.Study results. Comprehensive treatment of patients in both groups included surgical debridement of purulent foci, local treatment (NPWT or dressings with antiseptic solutions) and skin grafting or healing by secondary intention after the transition of the wound process to the reparative stage. None of the patients in both groups had a high amputation. Not a single fatal outcome has been recorded. In patients of the main group, the transition of the wound process to the reparative stage was carried out in a shorter time compared with those treated without NPWT.Conclusion. Treatment of the neuropathic form of DFS with the NPWT (for example, patients in Ghana) reduces the hospital stay and the number of high amputations of the lower extremities, and improves the quality of life of patients.

scholarly journals The use of the VersaJet hydrosurgical system in patients with diabetic foot syndrome

2010 ◽  
Vol 13 (3) ◽  
pp. 121-126
Author(s):  
Lyudmila Petrovna Doronina ◽  
Valeriy Afanas'evich Mitish ◽  
Gagik Radikovich Galstyan
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Treatment Duration ◽  
Diabetic Foot Syndrome ◽  
Adequate Treatment ◽  
Technical Problems ◽  
Medical Aid ◽  
Foot Lesions ◽  
Multifactor Approach

The management of chronic lesions in DM patients implies a multifactor approach, its important component being the adequate treatment of thewound bed. The new hydrosurgical technology for the purpose based on the VersaJet system poses a number of technical problems and requires assessmentof its applicability and efficiency in patients with different forms of diabetic foot syndrome. Results of the work with this system (62 patients)revealed its advantages, such as reduction of treatment duration and the number of repeat treatments, higher probability of wound healing at sitesdifficult to access (heel, tendon projection regions, etc.). It is concluded that the VersaJet system may be recommended for the use in surgical departmentsproviding specialized medical aid to patients with DM and pyonecrotic foot lesions.

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